<?xml version="1.0" encoding="UTF-8"?>
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<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
  <head>
    <title>新增病人风险评估表</title>
    <meta http-equiv="keywords" content="enter,your,keywords,here" />
    <meta http-equiv="description" content="A short description of this page." />
    <meta http-equiv="content-type" content="text/html; charset=UTF-8" />
    <#include "/template/head.html">
    <script type="text/javascript" src="${basePath}js/jquery.area.js" charset="utf-8"></script>
    <script type="text/javascript"> 
    $.metadata.setType("attr", "validate");
    $(document).ready(function() {
      curDate("#tbrq");
      $("#fxpgbForm").validate();
      $().area({xmlPath:"${basePath}Area.xml"});
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    </script> 
  </head>
  <body>
    <form id="fxpgbForm" action="${basePath}brxx/save.do" method="post">
      <table class="cmxform" cellspacing="1">
        <caption>新&nbsp;&nbsp;增&nbsp;&nbsp;病&nbsp;&nbsp;人&nbsp;&nbsp;风&nbsp;&nbsp;险&nbsp;&nbsp;评&nbsp;&nbsp;估&nbsp;&nbsp;表</caption>
        <tr>
          <th width="12%">KICID号：</th>
          <td width="38%"><input name="kicid" value="${baseInfo.kicid}" class="disabled" readonly/></td>
          <th width="12%">病人姓名：</th>
          <td width="38%"><input name="brxm" value="${baseInfo.brxm}" class="disabled" readonly/></td>
        </tr>
        <tr>
          <th>访视者：</th>
          <td><input name="fszxm" validate="rangelength:[1,4]" /></td>
          <th>填表日期：</th>
          <td><input id="tbrq" name="tbrq" class="Wdate required date" /></td>
        </tr>
        <tr>
          <td colspan="4">
            <span style="color:blue">本表填写说明：日期格式 yyyy-MM-dd；</span>
            <br /> 一、病人基本情况
          </td>
        </tr>
        <tr>
          <th>出生地：</th>
          <td colspan="3">
            <select id="provinceId" name="part1.province">
              <option value="" selected="selected">省/直辖市</option>
            </select>
            <select id="cityId" name="part1.city">
              <option value="" selected="selected">请选择</option>
            </select>
            <select id="countryId" name="part1.country">
              <option value="" selected="selected">请选择</option>
            </select>
            <span id="qrsdrq_warp">
              <label for="part1.qrsdrq">若不是山东地区出生，何时迁入：</label>
              <input name="part1.qrsdrq" class="Wdate date"/>
            </span>
          </td>
        </tr>
        <tr>
          <th>是否曾在军队服役：</th>
          <td colspan="3">
            <span onclick="rotDis('part1.fy', 'checked', [1], 'tb_fy_detail')">
              <input type="radio" name="part1.fy" value="1" class="required"/>是
              <input type="radio" name="part1.fy" value="2"/>否
              <input type="radio" name="part1.fy" value="3"/>不详
              <label for="part1.fy" class="error">*</label>
            </span>
            <table id="tb_fy_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="12%">何时服役：</th>
                <td width="38%">从 <input name="part1.fyqs" disabled="disabled" class="w60 number"/> 年至  <input name="part1.fyjz" disabled="disabled" class="w60 number"/></td>
                <th width="12%">何处服役：</th>
                <td width="38%"><input name="part1.fyaddr" disabled="disabled"/></td>
              </tr>
            </table>
          </td>
        </tr>
        <tr>
          <th>当前婚姻状况：</th>
          <td>
            <select name="part1.hyzk" class="required">
              <option value=""></option>
              <#list constants.hyzk as item>
              <option value="${item_index+1}">${item}</option>
              </#list>
            </select><label for="part1.hyzk" class="error">*</label>
          </td>
          <th>出现症状前或者出现症状时的居住地：</th>
          <td>
            <input name="part1.hbaddr" />
          </td>
        </tr>
        <tr>
          <th>接受了多少年的教育：</th>
          <td colspan="3">
            <input name="part1.jynx" class="number"/> 年
            <label for="atSchool">目前是否仍在校？</label>
            <span onclick="rotDis('part1.atSchool', 'checked', [1], 'school_warp')">
              <input type="radio" name="part1.atSchool" value="1" class="required"/>是
              <input type="radio" name="part1.atSchool" value="0"/>否
              <label for="part1.atSchool" class="error">*</label>
            </span>
            <span id="school_warp" class="none">
              <label for="part1.school">学校名称：</label>
              <input name="part1.school" disabled="disabled"/>
            </span>
          </td>
        </tr>
        <tr>
          <th colspan="4" class="indent2em left">
            <label>你目前（在患病/有症状/就医的3个月内）是否在工作或做临时工：</label>
            <span onclick="rotDis('part1.worked', 'checked', [1], 'tb_worked_detail');rotDis('part1.worked', 'checked', [0], 'tb_unworked_detail')">
              <input type="radio" name="part1.worked" value="1" class="required"/>是
              <input type="radio" name="part1.worked" value="0"/>否
              <label for="part1.worked" class="error">*</label>
            </span>
            <table id="tb_worked_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">你最近的职业是什么：</th>
                <td width="80%">
                  <input name="part1.zjzy" disabled="disabled"/>
                </td>
              </tr>
              <tr>
                <th width="20%">工作场所位置（地址或街道）：</th>
                <td width="80%">
                  <input name="part1.gzcs" disabled="disabled"/>
                </td>
              </tr>
              <tr>
                <th width="20%">你在这里工作了多长时间：</th>
                <td width="80%">
                  <input name="part1.gzsj" disabled="disabled"/>
                </td>
              </tr>
            </table>
            <table id="tb_unworked_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">最近一次被雇佣的时间：</th>
                <td width="80%">
                  <input name="part1.zjgzrq" disabled="disabled" class="Wdate date"/>
                </td>
              </tr>
              <tr>
                <th width="20%">你是否退休/伤残或未就业5年以上：</th>
                <td width="80%">
                  <input name="part1.wgz5n" type="radio" value="1" disabled="disabled"/>是
                  <input name="part1.wgz5n" type="radio" value="0" disabled="disabled"/>否
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>你是否曾经待过拘留所：</label>
            <span onclick="rotDis('part1.jls', 'checked', [1], 'tb_jls_detail')">
              <input type="radio" name="part1.jls" value="1" class="required"/>是
              <input type="radio" name="part1.jls" value="0"/>否
              <label for="part1.jls" class="error">*</label>
            </span>
            <table id="tb_jls_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">你是什么时间进的拘留所：</th>
                <td width="80%">
                  <input name="part1.jlsrq" disabled="disabled" class="Wdate date"/>
                </td>
              </tr>
              <tr>
                <th width="20%">你总共在拘留所中待了多长时间：</th>
                <td width="80%">
                  <input name="part1.jlssc" disabled="disabled" class="number"/> 月
                </td>
              </tr>
              <tr>
                <th width="20%">拘留所在何处：</th>
                <td width="80%">
                  <input name="part1.jlsaddr" disabled="disabled"/>（详细名称和位置）
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>你是否曾经待过监狱：</label>
            <span onclick="rotDis('part1.jail', 'checked', [1], 'tb_jail_detail')">
              <input type="radio" name="part1.jail" value="1" class="required"/>是
              <input type="radio" name="part1.jail" value="0"/>否
              <label for="part1.jail" class="error">*</label>
            </span>
            <table id="tb_jail_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">你是什么时间进的监狱：</th>
                <td width="80%">
                  <input name="part1.jailrq" disabled="disabled" class="Wdate date"/>
                </td>
              </tr>
              <tr>
                <th width="20%">你总共在监狱中待了多长时间：</th>
                <td width="80%">
                  <input name="part1.jailsc" disabled="disabled" class="number"/> 月
                </td>
              </tr>
              <tr>
                <th width="20%">监狱在何处：</th>
                <td width="80%">
                  <input name="part1.jailaddr" disabled="disabled"/>（详细名称和位置）
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <td colspan="4">二、病人生活情况</td>
        </tr>
        <tr>
          <th>目前生活在哪里：</th>
          <td colspan="3">
            <select name="part2.liveat" onchange="rotDis('part2.liveat', 'selected', ['家里', '集体宿舍', '宾馆或出租房', '其它'], 'liveat_warp')">
              <option value=""></option>
              <#list constants.liveat as item>
              <option value="${item_index+1}">${item}</option>
              </#list>
            </select>
            <br />
            <span id="liveat_warp" class="none">
              <label for="part2.liveTime">居住了多长时间？</label>
              <input name="part2.liveTime" disabled="disabled"/>
              <label for="part2.liveAddr">（详细名称和位置）</label>
              <input name="part2.liveAddr" disabled="disabled"/>
            </span>
          </td>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>包括你本人共有多少成人/儿童住在那里？</label>
            <input name="part2.numberOfAdults" class="w60 number"/>（成人＞=18岁）
            <input name="part2.numberOfChildren" class="w60 number"/>（儿童＜18岁）
            <label>家里共有多少间？</label><input name="part2.numberOfRoom" class="w60 number"/>
          </th>
        </tr>
        <tr>
          <th>家庭年总收入：</th>
          <td colspan="3">
            <select name="part2.income">
              <option value=""></option>
              <#list constants.income as item>
              <option value="${item_index+1}">${item}</option>
              </#list>
            </select>
          </td>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>请给出了解你情况的联系人（如母亲或亲属）的名字和电话：</label><br />
            <label>详细名称</label><input name="part2.relative"/>
            <label>亲属关系</label><input name="part2.relationship"/>
            <label>电话号码</label><input name="part2.relativeTel"/>
          </th>
        </tr>
        <tr>
          <td colspan="4">三、旅行和社会接触</td>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>在你有症状之前2年内，是否曾与临时来山东的亲属、朋友有过任何接触：</label>
            <span onclick="rotDis('part3.contact', 'checked', [1], 'tb_contact_detail')">
              <input type="radio" name="part3.contact" value="1"/>是
              <input type="radio" name="part3.contact" value="0"/>否
            </span>
            <table id="tb_contact_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">接触人姓名：</th>
                <td width="80%">
                  <input name="part3.cttPeople" disabled="disabled"/>
                </td>
              </tr>
              <tr>
                <th width="20%">地点（详细名称和地址）：</th>
                <td width="80%">
                  <input name="part3.cttAddr" disabled="disabled"/>
                </td>
              </tr>
              <tr>
                <th width="20%">亲属关系：</th>
                <td width="80%">
                  <input name="part3.cttRelationship" disabled="disabled"/>
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>在你有症状之前6个月内，你是否曾到山东之外旅游：</label>
            <span onclick="rotDis('part3.travel', 'checked', [1], 'tb_travel_detail')">
              <input type="radio" name="part3.travel" value="1"/>是
              <input type="radio" name="part3.travel" value="0"/>否
            </span>
            <table id="tb_travel_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">共有多少次旅游：</th>
                <td width="80%">
                  <input name="part3.tvlTimes" disabled="disabled" class="number"/> 次
                </td>
              </tr>
              <tr>
                <th width="20%">最后一次到何处：</th>
                <td width="80%">
                  <input name="part3.lastTvlAddr" disabled="disabled"/>
                </td>
              </tr>
              <tr>
                <th width="20%">在那里停留了多长时间：</th>
                <td width="80%">
                  <input name="part3.tvlStayDays" disabled="disabled" class="number"/> 天
                </td>
              </tr>
              <tr>
                <th width="20%">此次旅游的原因：</th>
                <td width="80%">
                  <select name="part3.tvlReason" disabled="disabled" onchange="rotDis('part3.tvlReason', 'selected', ['其它'], 'trr_warp')">
                    <option value=""></option>
                    <#list constants.tvlreason as item>
                    <option value="${item_index+1}">${item}</option>
                    </#list>
                  </select>
                  <span id="trr_warp" class="none">
                    <label for="part3.tvlReasonRemark">注明</label>
                    <input name="part3.tvlReasonRemark" disabled="disabled"/>
                  </span>
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>除家庭、学校或工作单位之外，是否还有你每周去过2次以上的地方：</label>
            <span onclick="rotDis('part3.place', 'checked', [1], 'tb_place_detail')">
              <input type="radio" name="part3.place" value="1"/>是
              <input type="radio" name="part3.place" value="0"/>否
            </span>
            <table id="tb_place_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">
                  <label>酒吧</label>
                  <input type="checkbox" name="part3.bar" value="1" disabled="disabled" onclick="rotDis('part3.bar', 'checked', [1], 'bar_warp')"/>
                </th>
                <td width="80%">
                  <span id="bar_warp" class="none">
                    <label>名称：</label><input name="part3.barName" disabled="disabled"/>
                    <label>位置：</label><input name="part3.barAddr" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>
                  <label>餐馆或其它饮食店</label>
                  <input type="checkbox" name="part3.restaurant" value="1" disabled="disabled" onclick="rotDis('part3.restaurant', 'checked', [1], 'ctt_warp')"/>
                </th>
                <td>
                  <span id="ctt_warp" class="none">
                    <label>名称：</label><input name="part3.rttName" disabled="disabled"/>
                    <label>位置：</label><input name="part3.rttAddr" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>
                  <label>农贸市场或集市</label>
                  <input type="checkbox" name="part3.market" value="1" disabled="disabled" onclick="rotDis('part3.market', 'checked', [1], 'market_warp')"/>
                </th>
                <td>
                  <span id="market_warp" class="none">
                    <label>名称：</label><input name="part3.marketName" disabled="disabled"/>
                    <label>位置：</label><input name="part3.marketAddr" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>
                  <label>诊所或医院</label>
                  <input type="checkbox" name="part3.hospital" value="1" disabled="disabled" onclick="rotDis('part3.hospital', 'checked', [1], 'hospital_warp')"/>
                </th>
                <td>
                  <span id="hospital_warp" class="none">
                    <label>名称：</label><input name="part3.hospitalName" disabled="disabled"/>
                    <label>位置：</label><input name="part3.hospitalAddr" disabled="disabled"/>
                  </span>
                </td>
              </tr>
              <tr>
                <th>
                  <label>另外常去地方</label>
                  <input type="checkbox" name="part3.otherPlace" value="1" disabled="disabled" onclick="rotDis('part3.otherPlace', 'checked', [1], 'otherPlace_warp')"/>
                </th>
                <td>
                  <span id="otherPlace_warp" class="none">
                    <label>名称：</label><input name="part3.otherPlaceName" disabled="disabled"/>
                    <label>位置：</label><input name="part3.otherPlaceAddr" disabled="disabled"/>
                  </span>
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <td colspan="4">四、烟草/酒精接触史</td>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>在与您同住的人中是否有人吸烟：</label>
            <span onclick="rotDis('part4.havesf', 'checked', [1], 'havesf_warp')">
              <input type="radio" name="part4.havesf" value="1"/>是
              <input type="radio" name="part4.havesf" value="0"/>否
            </span>
            <span id="havesf_warp" class="none">
              <label for="part4.numOfsf">吸烟人数</label>
              <input name="part4.numOfsf" disabled="disabled" class="w40 number"/>
            </span>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>你是吸烟者吗：</label>
            <span onclick="rotDis('part4.smoker', 'checked', [1], 'tb_smoker_detail')">
              <input type="radio" name="part4.smoker" value="1"/>是
              <input type="radio" name="part4.smoker" value="0"/>否
            </span>
            <table id="tb_smoker_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">
                  <label>如何描述您的吸烟史：</label>
                </th>
                <td width="80%">
                  <input type="radio" name="part4.descOfSmoking" value="1" disabled="disabled"/>以前吸烟
                  <input type="radio" name="part4.descOfSmoking" value="2" disabled="disabled"/>当前吸烟
                </td>
              </tr>
              <tr>
                <th width="20%">
                  <label>您每天吸几包烟：</label>
                </th>
                <td width="80%">
                  <input name="part4.cigaret" disabled="disabled" class="number"/> 包/天
                </td>
              </tr>
              <tr>
                <th width="20%">
                  <label>您吸烟有多长时间：</label>
                </th>
                <td width="80%">
                  <input name="part4.smokingHistory" disabled="disabled"/>
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>半年内是否饮酒</label>
            <span onclick="rotDis('part4.drinking', 'checked', [1], 'tb_drinking_detail')">
              <input type="radio" name="part4.drinking" value="1"/>是
              <input type="radio" name="part4.drinking" value="0"/>否
            </span>
            <table id="tb_drinking_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="30%">
                  <label>您引用含酒精饮料（啤酒、红酒、高度酒）的频度如何：</label>
                </th>
                <td width="70%">
                  <select name="part4.fqcOfDrinking" disabled="disabled">
                    <option value=""></option>
                    <#list constants.fqcOfDrinking as item>
                    <option value="${item_index+1}">${item}</option>
                    </#list>
                  </select>
                </td>
              </tr>
              <tr>
                <th><label>您在一天中经常喝多少（饮用数量和酒品种类）：</label></th>
                <td><input name="part4.drinkEachDay" disabled="disabled"/></td>
              </tr>
              <tr>
                <th>
                  <label>您饮酒已经有多长时间了：</label>
                </th>
                <td>
                  <input name="part4.drinkingHistory" disabled="disabled"/>
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <td colspan="4">五、病人医疗史</td>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>你过去是否曾被告知（诊断）患有结核病：</label>
            <input type="radio" name="part5.diagnosedAsTB" value="1"/>是
            <input type="radio" name="part5.diagnosedAsTB" value="2"/>否
            <input type="radio" name="part5.diagnosedAsTB" value="3"/>不详
          </th>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>你是否与曾被告知（诊断）患有结核病的任何人有过接触（并非指强阳性结核菌素皮肤实验结果）</label>
            <span onclick="rotDis('part5.contactTB', 'checked', [1], 'tb_contactTB_detail')">
              <input type="radio" name="part5.contactTB" value="1"/>是
              <input type="radio" name="part5.contactTB" value="2"/>否
              <input type="radio" name="part5.contactTB" value="3"/>不详
            </span>
            <table id="tb_contactTB_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="20%">被诊断人姓名：</th>
                <td width="30%"><input name="part5.nameOfTB" disabled="disabled"/></td>
                <th width="20%">你与他/她的关系：</th>
                <td width="30%"><input name="part5.relationWithTB" disabled="disabled"/></td>
              </tr>
              <tr>
                <th>他/她是何时被诊断的：</th>
                <td><input name="part5.dateOfDiagnosis" disabled="disabled" class="Wdate date"/></td>
                <th>他/她是在何处被诊断的：</th>
                <td><input name="part5.diagnosisLocations" disabled="disabled"/></td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th colspan="4" class="left indent2em">
            <label>自1978年以后，你是否接受过输血或血液制品（自然存在于人类血液中的物质，如血小板、第8因子、血浆）</label>
            <span onclick="rotDis('part5.contactBlood', 'checked', [1], 'tb_contactBlood_detail')">
              <input type="radio" name="part5.contactBlood" value="1"/>是
              <input type="radio" name="part5.contactBlood" value="0"/>否
            </span><br />
            <table id="tb_contactBlood_detail" class="none inform" cellspacing="1">
              <tr>
                <th width="30%">你最后一次接受是在什么时间：</th>
                <td width="70%"><input name="part5.dateOfLastCtt" disabled="disabled" class="date"/></td>
              </tr>
              <tr>
                <th>你是否患有血友病或出血紊乱症：</th>
                <td>
                  <input type="radio" name="part5.hemophilia" value="1" disabled="disabled"/>是
                  <input type="radio" name="part5.hemophilia" value="0" disabled="disabled"/>否
                </td>
              </tr>
            </table>
          </th>
        </tr>
        <tr>
          <th>你是否做过定期检查：</th>
          <td colspan="3">
            <span onclick="rotDis('part5.physicalExam', 'checked', [1], 'examOrg_warp')">
              <input type="radio" name="part5.physicalExam" value="1"/>是
              <input type="radio" name="part5.physicalExam" value="2"/>否
              <input type="radio" name="part5.physicalExam" value="3"/>不详
            </span>
            <span id="examOrg_warp" class="none">
              <label for="part5.examOrg">做体检的机构名称</label><input name="part5.examOrg" disabled="disabled"/>
            </span>
          </td>
        </tr>
        <tr>
          <td colspan="4">六、病人病史</td>
        </tr>
        <tr>
          <td colspan="4"><table class="cmxform" cellspacing="1">
            <tr>
              <th width="15%">哮喘：</th>
              <td width="35%">
                <input type="radio" name="part6.xc" value="1"/>是
                <input type="radio" name="part6.xc" checked value="2"/>否
                <input type="radio" name="part6.xc" value="3"/>不详
              </td>
              <th width="15%">慢性阻塞性肺病：</th>
              <td width="35%">
                <input type="radio" name="part6.mxzsxfb" value="1"/>是
                <input type="radio" name="part6.mxzsxfb" checked value="2"/>否
                <input type="radio" name="part6.mxzsxfb" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>支气管扩张：</th>
              <td>
                <input type="radio" name="part6.zqgkz" value="1"/>是
                <input type="radio" name="part6.zqgkz" checked value="2"/>否
                <input type="radio" name="part6.zqgkz" value="3"/>不详
              </td>
              <th>矽肺病：</th>
              <td>
                <input type="radio" name="part6.xfb" value="1"/>是
                <input type="radio" name="part6.xfb" checked value="2"/>否
                <input type="radio" name="part6.xfb" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>结核病（陈旧）：</th>
              <td>
                <input type="radio" name="part6.TB" value="1"/>是
                <input type="radio" name="part6.TB" checked value="2"/>否
                <input type="radio" name="part6.TB" value="3"/>不详
              </td>
              <th>非典型结核病：</th>
              <td>
                <input type="radio" name="part6.fdxTB" value="1"/>是
                <input type="radio" name="part6.fdxTB" checked value="2"/>否
                <input type="radio" name="part6.fdxTB" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>放疗：</th>
              <td>
                <input type="radio" name="part6.fl" value="1"/>是
                <input type="radio" name="part6.fl" checked value="2"/>否
                <input type="radio" name="part6.fl" value="3"/>不详
              </td>
              <th>胸壁畸形或外伤：</th>
              <td>
                <input type="radio" name="part6.xbjx" value="1"/>是
                <input type="radio" name="part6.xbjx" checked value="2"/>否
                <input type="radio" name="part6.xbjx" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>糖尿病：</th>
              <td>
                <input type="radio" name="part6.tnb" value="1"/>是
                <input type="radio" name="part6.tnb" checked value="2"/>否
                <input type="radio" name="part6.tnb" value="3"/>不详
              </td>
              <th>类肉瘤病：</th>
              <td>
                <input type="radio" name="part6.lrlb" value="1"/>是
                <input type="radio" name="part6.lrlb" checked value="2"/>否
                <input type="radio" name="part6.lrlb" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>纤维性囊肿：</th>
              <td>
                <input type="radio" name="part6.xwxzl" value="1"/>是
                <input type="radio" name="part6.xwxzl" checked value="2"/>否
                <input type="radio" name="part6.xwxzl" value="3"/>不详
              </td>
              <th>结缔组织病：</th>
              <td>
                <input type="radio" name="part6.jdzzb" value="1"/>是
                <input type="radio" name="part6.jdzzb" checked value="2"/>否
                <input type="radio" name="part6.jdzzb" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>胃部手术：</th>
              <td>
                <input type="radio" name="part6.wbss" value="1"/>是
                <input type="radio" name="part6.wbss" checked value="2"/>否
                <input type="radio" name="part6.wbss" value="3"/>不详
              </td>
              <th>肺癌：</th>
              <td>
                <input type="radio" name="part6.fa" value="1"/>是
                <input type="radio" name="part6.fa" checked value="2"/>否
                <input type="radio" name="part6.fa" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>其他肿瘤：</th>
              <td>
                <input type="radio" name="part6.qtzl" value="1"/>是
                <input type="radio" name="part6.qtzl" checked value="2"/>否
                <input type="radio" name="part6.qtzl" value="3"/>不详
              </td>
              <th>充血性心衰：</th>
              <td>
                <input type="radio" name="part6.cxxxs" value="1"/>是
                <input type="radio" name="part6.cxxxs" checked value="2"/>否
                <input type="radio" name="part6.cxxxs" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>肾衰：</th>
              <td>
                <input type="radio" name="part6.ss" value="1"/>是
                <input type="radio" name="part6.ss" checked value="2"/>否
                <input type="radio" name="part6.ss" value="3"/>不详
              </td>
              <th>高血压：</th>
              <td>
                <input type="radio" name="part6.gxy" value="1"/>是
                <input type="radio" name="part6.gxy" checked value="2"/>否
                <input type="radio" name="part6.gxy" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>肝病：</th>
              <td>
                <input type="radio" name="part6.gb" value="1"/>是
                <input type="radio" name="part6.gb" checked value="2"/>否
                <input type="radio" name="part6.gb" value="3"/>不详
              </td>
              <th>甲型肝炎：</th>
              <td>
                <input type="radio" name="part6.jxgy" value="1"/>是
                <input type="radio" name="part6.jxgy" checked value="2"/>否
                <input type="radio" name="part6.jxgy" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>乙型肝炎：</th>
              <td>
                <input type="radio" name="part6.yxgy" value="1"/>是
                <input type="radio" name="part6.yxgy" checked value="2"/>否
                <input type="radio" name="part6.yxgy" value="3"/>不详
              </td>
              <th>丙型肝炎：</th>
              <td>
                <input type="radio" name="part6.bxgy" value="1"/>是
                <input type="radio" name="part6.bxgy" checked value="2"/>否
                <input type="radio" name="part6.bxgy" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>梅毒：</th>
              <td>
                <input type="radio" name="part6.md" value="1"/>是
                <input type="radio" name="part6.md" checked value="2"/>否
                <input type="radio" name="part6.md" value="3"/>不详
              </td>
              <th>淋病：</th>
              <td>
                <input type="radio" name="part6.lb" value="1"/>是
                <input type="radio" name="part6.lb" checked value="2"/>否
                <input type="radio" name="part6.lb" value="3"/>不详
              </td>
            </tr>
            <tr>
              <th>免疫抑制疗法：</th>
              <td>
                <input type="radio" name="part6.myyzlf" value="1"/>是
                <input type="radio" name="part6.myyzlf" checked value="2"/>否
                <input type="radio" name="part6.myyzlf" value="3"/>不详
              </td>
              <th>整形手术：</th>
              <td>
                <span onclick="rotDis('part6.zxss', 'checked', [1], 'zxsslx_warp')">
                  <input type="radio" name="part6.zxss" value="1"/>是
                  <input type="radio" name="part6.zxss" checked value="2"/>否
                  <input type="radio" name="part6.zxss" value="3"/>不详
                </span>
                <span id="zxsslx_warp" class="none">
                  <label for="part6.zxsslx">类型</label><input name="part6.zxsslx" disabled="disabled"/>
                </span>
              </td>
            </tr>
            <tr>
              <th>其他手术：</th>
              <td>
                <span onclick="rotDis('part6.qtss', 'checked', [1], 'qtsslx_warp')">
                  <input type="radio" name="part6.qtss" value="1"/>是
                  <input type="radio" name="part6.qtss" checked value="2"/>否
                  <input type="radio" name="part6.qtss" value="3"/>不详
                </span>
                <span id="qtsslx_warp" class="none">
                  <label for="part6.qtsslx">类型</label><input name="part6.qtsslx" disabled="disabled"/>
                </span>
              </td>
              <th>严重外伤：</th>
              <td>
                <span onclick="rotDis('part6.ws', 'checked', [1], 'wslx_warp')">
                  <input type="radio" name="part6.ws" value="1"/>是
                  <input type="radio" name="part6.ws" checked value="2"/>否
                  <input type="radio" name="part6.ws" value="3"/>不详
                </span>
                <span id="wslx_warp" class="none">
                  <label for="part6.wslx">类型</label><input name="part6.wslx" disabled="disabled"/>
                </span>
              </td>
            </tr>
            <tr>
              <th>其他：</th>
              <td colspan="3">
                <input name="part6.qt"/>
              </td>
            </tr>
          </table></td>
        </tr>
        <tfoot>
          <tr>
            <td colspan="4">
              <input type="hidden" name="curStep" value="fxpgb"/>
              <input type="hidden" name="chain" value="${chain}"/>
              <input type="hidden" id="action" name="action" value="forward"/>
              <button type="button" class="back" onclick="$('#action').val('reverse');$('#fxpgbForm').submit()"></button>&nbsp;&nbsp;&nbsp;
              <button type="button" class="save" onclick="$('#fxpgbForm').submit()"></button>&nbsp;&nbsp;&nbsp;
              <button type="button" class="submit" onclick="if(confirm('你确认提交吗，提交后不再允许修改？')){$('#action').val('submit');$('#fxpgbForm').submit();}else{return false;}"></button>
            </td>
          </tr>
        </tfoot>
      </table>
    </form>
  </body>
</html>
